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NPI Code Detail

MEDICARE: DR. YONGSOK DO D.M.D

MEDICARE: DR. YONGSOK DO D.M.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0221XPediatric DentistryDS035178PA
21223P0221XPediatric DentistryDT-2316HI

General Provider Information

NPI Number : 1730104407
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. YONGSOK DO D.M.D
Provider Business Mailing Address
First Line : 91-2139 FORT WEAVER RD
Second Line : SUITE 301
City : EWA BEACH
State : HI
Zip : 96706-3607
Country : US
Telephone Number : 808-680-9411
Fax Number : 808-676-9847
Provider Business Practice Location Address
First Line : 91-2139 FORT WEAVER RD
Second Line : SUITE 301
City : EWA BEACH
State : HI
Zip : 96706-3607
Country : US
Telephone Number : 808-680-9411
Fax Number : 808-676-9847
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2006
Last Update Date : 04/12/2011

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